<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
        "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
    <title>Ready to register with eMart?</title>
    <link rel="stylesheet" href="css/style.css">
</head>
<body>
<div id="header">
    <div id="logo">
        <a href="index.html"><img src="images/logo.png" alt="Our Logo" width="153"></a>
    </div>
    <div class="clear"></div>
    <hr>
    <h2>Edit Your Profile?</h2>
    <p style="font-size: 14px;">Making changes to your account?</p>
</div>
<div id="main_body">
<div id="main_form">
     
        <br>
        <div id="input_fname">
            <p>First Name*:</p>
            <input type="text" name="fn" size="17px">
        </div>
        
        <div id="input_lname">
            <p>Last Name*:</p>
            <input type="text" name="ln" size="18px">
        </div>

        <p>Day of Birth:</p>
        <select name="bd_date">
            <optgroup label="Day">
                <option value="0">-Day-</option>
                <option value="1">January</option>
                <option value="2">February</option>
                <option value="3">March</option>
                <option value="4">April</option>
                <option value="5">May</option>
                <option value="6">June</option>
                <option value="7">July</option>
                <option value="8">August</option>
                <option value="9">September</option>
                <option value="10">October</option>
                <option value="11">November</option>
                <option value="12">December</option>
            </optgroup>
        </select>
        <select name="bd_month">
            <optgroup label="Month">
                <option value="0">-Month-</option>
                <option value="1">01</option>
                <option value="2">02</option>
                <option value="3">03</option>
                <option value="4">04</option>
                <option value="5">05</option>
                <option value="6">06</option>
                <option value="7">07</option>
                <option value="8">08</option>
                <option value="9">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
                <option value="13">13</option>
                <option value="14">14</option>
                <option value="15">15</option>
                <option value="16">16</option>
                <option value="17">17</option>
                <option value="18">18</option>
                <option value="19">19</option>
                <option value="20">20</option>
                <option value="21">21</option>
                <option value="22">22</option>
                <option value="23">23</option>
                <option value="24">24</option>
                <option value="25">25</option>
                <option value="26">26</option>
                <option value="27">27</option>
                <option value="28">28</option>
                <option value="29">29</option>
                <option value="30">30</option>
                <option value="31">31</option>
            </optgroup>
        </select>

        <select name="bd_date">
            <optgroup label="Year">
                <option value="0">-Year-</option>
                <option value="1">1993</option>
                <option value="2">1992</option>
                <option value="3">1991</option>
                <option value="4">1990</option>
                <option value="5">1989</option>
                <option value="6">1988</option>
                <option value="7">1987</option>
                <option value="8">1986</option>
                <option value="9">1985</option>
                <option value="10">1984</option>
                <option value="11">1983</option>
                <option value="12">1982</option>
                <option value="13"><1982</option>
            </optgroup>
        </select>
        <p>Email*:</p>
        <input type="text" name="mail" size="30px">
        <p>Address:</p>
    <p>
          <input type="text" name="add" size="30px">
    </p>
    <p>Phone number:</p>
    <p>
      <input type="text" name="add4" size="30px">
    </p>
    <fieldset id ="credit" class="clearfix">
	<legend class="ftoggler">Change credit card</legend>
    <p>Cardholder name:</p>
    <p>
      <input type="text" name="add7" size="30px">
    </p>
    <p>Credit card number: </p>
    <p>
      <input type="text" name="add5" size="30px">
    </p>
    <p>Expiry date:</p>
    <p>
      <select name="bd_month2">
        <optgroup label="Month">
          <option value="0">-Month-</option>
          <option value="1">01</option>
          <option value="2">02</option>
          <option value="3">03</option>
          <option value="4">04</option>
          <option value="5">05</option>
          <option value="6">06</option>
          <option value="7">07</option>
          <option value="8">08</option>
          <option value="9">09</option>
          <option value="10">10</option>
          <option value="11">11</option>
          <option value="12">12</option>
          <option value="13">13</option>
          <option value="14">14</option>
          <option value="15">15</option>
          <option value="16">16</option>
          <option value="17">17</option>
          <option value="18">18</option>
          <option value="19">19</option>
          <option value="20">20</option>
          <option value="21">21</option>
          <option value="22">22</option>
          <option value="23">23</option>
          <option value="24">24</option>
          <option value="25">25</option>
          <option value="26">26</option>
          <option value="27">27</option>
          <option value="28">28</option>
          <option value="29">29</option>
          <option value="30">30</option>
          <option value="31">31</option>
          </optgroup>
      </select>
      <select name="bd_date2">
        <optgroup label="Year">
          <option value="0">-Year-</option>
          </optgroup>
      </select>
    </p>
    <p>Card identification number:</p>
    <p>
      <input type="text" name="add6" size="30px">
    </p>
    <p>&nbsp;</p>
    </fieldset>
      <fieldset id="moodle_interests" class="clearfix">
		<legend class="ftoggler">Change account info</legend>
		<p>Username*:</p>
		<p>
		  <input type="text" name="add2" size="30px">
		</p>
		<p>Password*:</p>
		<p>
		  <input type="text" name="add3" size="30px">
		</p>
		<p>Current Avatar:<img width="64" height="64" alt="Avatar of User" src="" class="userpicture"></p>
		<p>
		  <input type="file" id="id_imagefile" name="imagefile">
		</p>
		<p>&nbsp; </p>
		<div class="advancedbutton"></div><div class="fcontainer clearfix">
		
		<div class="fitem">
		  <div class="fitemtitle"></div><div class="felement ftextarea"></div></div>
	</div></fieldset>
    <p>There are required fields in this form marked<img alt="Required field" src="http://courses.fit.hcmus.edu.vn/pix/req.gif">.</p>
        
<button name="ok" type="submit">Update</button>
        <button name="cancel" type="reset">Cancel</button>
  </div>
</div>
<div id="footer">
    <hr>
    <h4>Copyright &copy; 2011 eMart Inc. All rights reserved.</h4>
    <div id="about">
        <a href="about.html"><h3>About</h3></a>
        <a href="about.html"><h3>Contact Us</h3></a>
    </div>
</div>
</body>
</html>